Cystoscopes and endoscopes are commonly used in a variety of procedures in which the physician must visually examine an internal portion of the body. Cystoscopes, in particular, are used by urologists to examine the urethra and bladder to diagnose urethral, prostate and bladder abnormalities. The cystoscope enables the internal regions of the urinary tract to be inspected, without the need for painful incisions, by enabling the viewer to insert a distal portion of the cystoscope through the urethra from whence it is moved to its final location within the urinary tract.
A cystoscope according to the prior art is detailed in FIG. 1. The cystoscope 20 includes a housing or handle 22 having an elongated distal portion 24 that supports a flexible tube 26. The handle 22 also includes an eye piece 28 at the proximal end of the handle 22. The eye piece 28 can include a zoom adjustment knob and/or a focus knob 30. Alternatively, the eye piece 28 can be substituted with a video camera for remote viewing. The tube 26 can vary in length, but is typically sized to penetrate the bladder through the urethra via the end of the penis. The tube 26 typically includes an outer covering 32 constructed from a low-friction polymer such as Teflon.RTM. or polyethelene. The tube can include an internal web or mesh that provides the tube 26 with a semi-rigid characteristic and protects the inner components. The distal end 34 of the tube 26 typically includes a polished metal end cap 35 having a plurality of exit ports which are described below.
The handle 22 includes a movable steering control 36 with a steering lever or knob 38. The steering lever moves (arrow 40) proximally and distally along the handle to control a pair of steering cables (not shown) within the tube 26. The steering cables enable the distal end 34 of the tube 26 to bend so that the tube 26 can negotiate bends and comers within the urinary tract as it is driven distally inward toward the bladder.
The steering control 36 is mounted on an enlarged ball 42 located between the proximal end and the distal end of the handle 22. The ball 42 is interconnected with a fiber optic light source cable 44 that communicates with a light source 46 according to the prior art. The light source 46 is, typically, a variable-intensity halogen lamp that draws power from a conventional 110 VAC power source via an electrical cord 48. An associated internal fiber optic cable (not shown) interconnects within the ball 42 of the handle 22 with the light source cable 44. A connector 50 is used to join the internal fiber optic cable (not shown) with the source cable 44. The internal fiber optic cable extends through the distal end 24 of the handle 22 and passes along the full length of the tube 26, and is exposed at the distal end 34 of the tube 26 to provide light at the distal end.
The tube 26 also includes a bundle of viewing fiber optic cables (not shown) that are also exposed at the distal end 34 of the tube 26. The viewing fiber optic cables (not shown) are connected with the eye piece 28 and transmit an image illuminated by the light source 46 from the distal end to the viewer.
According to the prior art, an irrigation/instrument assembly 52 or other fitting is provided at the distal end 24 of the handle 22. The assembly 52 interconnects with an internal tubing (not shown) that exits at the distal end 34 of the tube 26. The assembly 52 includes an instrument port 53 that provides a conduit for guiding an actuating mechanism of an instrument such as the grasper 55 located at the tube's distal end 34. A remote plunger assembly 54 with a movable finger control 59 controls the grasper 55. The irrigation/instrument assembly 52 also includes a fluid inlet 57 that can comprise a Luer-style fitting connected with a sterile tubing 56 that, in this embodiment, terminates in a source of sterile saline or water 58 suspended from a stand 60. According to the prior art, saline or sterile water 58 is used to distend the bladder and provide a fluidic light conduit that enhances the viewing environment by providing an enlarged viewing area with enhanced light transmission. Both instruments and fluid can pass down a single internal tubing (not shown) to exit at the distal end 34.
A disadvantage of the cystoscope 20, according to the prior art, is that the external light source 46 and stand-mounted saline source 58 are bulky, require additional space, and are difficult to transport. In addition, the external light source is an expensive component that is dependent upon a source of household current for power. Likewise, a bag or bottle of saline or sterile water is relatively expensive and substantial quantities must be stored and carried if a multiplicity of examinations are undertaken. These added external components, hence, limit the use of the prior art cystoscope 20 at remote sites. Additionally, the external components increase the set up time for the cystoscope, thus reducing the available time for performing examinations.
In view of the disadvantages of the prior art, it is an object of this invention to provide a portable cystoscope or endoscope that does not require an external source of saline or sterile water and that is internally illuminated. The cystoscope should adequately perform all functions associated with a cystoscope or endoscope having an external light source. The cystoscope or endoscope should include a mechanism for distending the urinary tract without the need of costly and bulky sources of fluid. The distension mechanism should be self- contained within the cystoscope or endoscope housing and should be usable for plurality of examinations without servicing.